Five Categories:› First category:

Individual must have been exposed to a trauma in which he or she was confronted with an event that involved actual or threatened death or serious injury, or a threat to self or others’ physical well-being

› Second category: Continuously reliving the traumatic event by dreams, recurrent recollections

of the event, flashback episodes, intense psychological distress that resemble trauma, and physiologic reactivity on exposure to events related to trauma

› Third category: Individual persistently avoiding stimuli in at least three ways including

attempting to avoid thoughts, feelings, activities, people, or situations associated with the trauma, diminishing interest in significant activities, voluntary social isolation, numbing feelings, and sensing a foreshortened future.

› Fourth category: Persistent symptoms of increased nervous system arousal by at least two

ways: difficulty sleeping, irritability, difficulty concentrating, hypervigilance, and exaggerated startle reactions.

› Fifth category: The person experience disturbance which causes clinically significant

distress or impairment in social, occupational, or other critical areas of living

Posttraumatic Stress Disorder was first recognized among Wars I and II Veterans. › originally called shell shock, combat

fatigue, and war neurosis Vietnam War

› human services professions and the public became aware of Veterans with Posttraumatic Stress Disorder

› began support groups to help cope with their issues with the war

About 14 percent of the general population in the USA is expected to experience PTSD in his or her lifetime

Symptoms in 90% of individuals with PTSD persisted longer than three months› Over 70% lasted longer than a year› More than 1/3 of people never fully recover

Roughly 30% of men and 27% of women of Vietnam Veterans had PTSD at some point in the lives

Approximately 24% Veterans of the Persian Gulf War has experienced Posttraumatic Stress Disorder

Dealings in Iraq and Afghanistan are still ongoing› Approximately 12.5% of those already deployed

and returned home has developed PTSD

Suicide is the 8th leading cause of death in the US› 13% of all Americans reported a history of

suicidal thoughts› 3.9% actually made a suicide plan› 4.6% reported they attempted suicide

Ages between 15-24 / 65 and older count for the largest portion of suicides in America

Veterans account for 20% who commit suicide

Male Veterans are twice as likely as civilians to commit suicide

People with mental disorders (PTSD) completed suicides 90% more than those without mental disorders

Used to identify warning signs of suicide: IS PATH WARM

› Ideation of suicide › Substance abuse

 › Purposelessness› Anxiety› Trapped › Hopelessness

 › Withdrawal › Anger › Recklessness › Mood change

Scale used to identify potential suicidal individuals: SAD PERSONS

› Sex (male) › Age (15-34, 65 & older) › Depression

 › Previous exposure to suicide › Ethanol (alcohol) drug use› Rational thinking loss› Social support system lacking › Organized plan › No spouse or significant

other › Sickness

About 2/3 of people who complete or attempt suicide are depressed› Must address the issue of depression

Symptoms of depression include weight loss or gain, increased or decreased sleep, fatigue, and inability to concentrate or make decisions› Interferes with one’s ability to function in

all areas of life (work, school, family, etc.)

Most commonly used treatments are antidepressants, psychotherapy, and electro-convulsive therapy (ECT).

More effective to start immediately with correct dosage to reduce the symptoms of depression in a timely fashion.

Side effects:› Dry mouth › Weight gain or loss

Overall, effective and highly favored

Group cognitive behavior therapy (CBT), individual CBT, and an interpersonal group therapy (IGT) approach are effective methods.

Mainly used when individuals are not responding to antidepressants and psychotherapy

Use an electrical shock to cause seizures in the brain which releases chemicals in the brain› Brain cells work better when these chemicals

are released which improves brain cells and make chemical messengers better

Side effects:› temporary short-term memory loss, confusion,

nausea, muscle aches and headache

A number of scales to detect PTSD:› CAPS-1, Mississippi Scale for Combat Related

PTSD, Impact of Events Scale, Keane PK Scales of MMPI/MMPI-2, etc.

Most Veterans with PTSD refuse early intervention due to denial and the idea that they should be able to deal with their own problems.› Important to educate people with PTSD in

order to accept their condition by removing self-blame, self-doubt, guilt and correct misunderstandings

Two main intervention/treatment methods for Veterans with PTSD: › Individual intervention

Cognitive Behavior Therapy and antidepressants

› Group intervention Couples’ therapy and Posttraumatic Stress

Disorder support groups

Teaches relaxation techniques, cognitive rewiring, anger management, and desensitization skills

Offers a means of increasing social support, decreasing interpersonal conflict, and addressing the experimental avoidance that maintains posttraumatic symptoms

May decrease PSTD symptoms and suicide risk:› Positive social support› Religion› Life satisfaction› Positive problem solving and coping skills› Positive therapeutic relationships› Responsibility to family members› Community support

Corcoran, J. & Walsh, J. (2009). Mental Health in Social Work. Boston, MA: Pearson Education, Inc.

Erbes, C., Polusny, M., MacDermid, S., & Compton, J. (2008). Couples therapy with combat veterans and their partners. Journal of Clinical PsychologyJames, R. (2008). Crisis Intervention Strategies. Belmont, CA: Thomson Brooks/Cole Corporation.

Friedman, M. (2006). Posttraumatic stress disorder among military returnees from Afghanistan and Iraq. American Journal of Psychiatry, 163, 586-593.

Jakupcak, M. & et al. (2006). A pilot study of behavioral activation for veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 19, 387-391.Suicide Prevention Resource Center (2006). Retrieved September 21, 2008 from http://webdev.sprc.org/thismonth/archives/thismonth_apr_jun06.asp.

Manguno-Mire, G. & et al. (2007). Psychological distress and burden among female partners of combat veterans with PTSD. Journal of Nervous and Mental Disease, 195, p. 144-151.

Tull, M. (2007). PTSD in Military Veterans. Retrieved September 23, 2008 from http://ptsd.about.com/od/prevalence/a/MilitaryPTSD.htm.

United States Department of Veteran Affairs (2008). What is Posttraumatic Stress Disorder (PTSD)? Retrieved September 22, 2008 from http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_what_is_ptsd.html